SCOPE OF THIS CHAPTER
This chapter outlines the increased vulnerability of disabled children and provides examples to help recognised such abuse. It also provides information about the role of Children's Social Care when there are concerns about a disabled child.
In July 2017, information on how to make a referral contained in Section 2, Recognition and Assessment of the Child's Needs, was updated to reflect current local processes in Derby City and Derbyshire.
- Recognition and Assessment of the Child's Needs
- Responding to Abuse of Disabled Children
The available UK evidence on the extent of abuse among disabled children suggests that disabled children are amongst the most vulnerable in society and at increased likelihood of abuse. Furthermore the presence of multiple disabilities increases the risk of both abuse and neglect.
Disabled children may be especially vulnerable to abuse for a number of reasons. Some disabled children may:
- Have fewer outside contacts than other children;
- Receive intimate personal care, possibly from a number of carers, which may both increase the risk of exposure to abusive behaviour, and make it more difficult to set and maintain physical boundaries;
- Have little or no choice about who provides them with intimate care;
- Have an impaired capacity to resist or avoid abuse;
- Have communication difficulties which may make it difficult to tell others what is happening;
- Experience the misuse or manipulation of the method by which they communicate, so that they either cannot express concerns or do not have the opportunity to express concerns;
- Be worried about complaining because of a fear of losing services;
- May particularly fear disclosing a perpetrator who is also a carer;
- Be especially vulnerable to bullying and intimidation;
- Be more vulnerable than other children to abuse by their peers; and
- Not understand or be aware of what is or is not appropriate behaviour.
The mistaken assumption that disability protects children from abuse contributes to the vulnerability of disabled children. Because of increased vulnerability it is particularly important for practitioners remain child focused and gain a clear perception of the individual child's experience of life and to be mindful not to collude with, or be over sympathetic to, parents/carers.Disabled children may not be believed when they report what has happened to them or may not understand what is and is not acceptable intervention by their carers.
Providers of services (statutory and voluntary) must have:
- An explicit commitment to, understanding of disabled children's needs, safety and a culture of openness;
- Guidelines and training for staff on: good practice in intimate care; working with children of the opposite sex; handling difficult behaviour, consent to treatment, e-safety and anti-bullying strategies, sexuality and sexual behaviour among young people and the vulnerabilities of those living away from home; and
- Have clear guidelines about the administration of drugs and medication.
Providers and individual practitioners should always ensure that all disabled children are helped to:
- Make their wishes and feelings known in respect of their care and treatment;
- Receive appropriate personal, health, and social education (including e-safety and sex education); and
- Know how to raise concerns, and give them access to a range of adults with whom they can communicate.
2. Recognition and Assessment of the Child's Needs
The indicators for abuse and neglect are the same for disabled children as they are for the wider population however their reaction or response may be less overt. Where children are observed to have bruising or other injuries it is important to consider all the possibilities and not to assume that it is a result of their disability.
Similarly when disabled children display behaviours that would cause concern in other children it is important not to make assumptions about its connection with the disability.
Where a child is unable to tell someone of her/his abuse s/he may convey anxiety or distress in some other way, for example behaviour or symptoms. Carers and staff must be alert to this and be aware of the possibility that challenging behaviour may be caused by something other than the disability.
Adults who may pose a risk to children may target disabled children in the belief that they are less likely to be detected and there may be more opportunities to groom disabled children.
Examples of the specific abuse of disabled children may include:
- Force feeding;
- Unjustified or excessive physical restraint or rough handling;
- Extreme behaviour modification including the deprivation of liquid, medication, food or clothing;
- Misuse of medication, sedation, heavy tranquilisation;
- Invasive procedures against the child's will;
- Deliberate failure to follow or misapplication of medically recommended regimes or programmes;
- Not attending appointments or not collecting prescriptions;
- Ill fitting or poorly maintained equipment which may cause injury or pain; and
- Not having their holistic developmental needs as children recognised or met due to excessive focus on disability.
Safeguards for disabled children are essentially the same as for non-disabled children. Where there are concerns about the welfare of a disabled child, their emerging vulnerabilities and needs should be assessed and met in the same way as with any other child.
Where a disabled child has communication impairments or learning disabilities, special attention should be paid to communication needs, and to ascertaining the child's perception of events and his or her wishes and feelings. This should be done with sufficient time and in a way that enables them to express themselves clearly. Sometimes this will require someone who knows the child and their individual style of communication well.
Disabled children are entitled to an assessment of their needs. Their family carers are also entitled to a carer's assessment. Agencies and practitioners should refer to the Derby City and Derbyshire Threshold Document (see Documents Library, Guidance Documents) to support them in their decision making about the child's needs and the appropriate assessment and interventions.
For disabled children with low level needs the Early Help Assessment may be used by any agency as a means of working with the child, family and other service providers to identify and meet emerging needs which could enable the child to achieve a satisfactory level of health and/or development. For further information please see the Providing Early Help Procedure.
Other disabled children will have more serious or complex needs and are unlikely to reach or maintain a satisfactory level of health or development; these children are entitled to receive assessment as a Child in Need. Where there are serious or complex needs Children's Social Care will carry out an Assessment to determine whether the child is in need, the nature of any services required, and whether any further specialised assessments are needed.
In Derby, the Integrated Disabled Children's Service is a multi-agency team which offers a range of support services for children with disabilities. An Early Help Assessment can be submitted to the weekly Vulnerable Children's Meetings at the Integrated Disabled Children's Service and referrals should be made to The Lighthouse via the Single Point of Access (SPA) Clerk. When the child and their family are known to other agencies, a completed Early Help Assessment Action Plan and the details of the Lead Professional should be submitted in support of the referral. If the criteria for assessment are not met, The Integrated Disabled Children's Service will re-direct referrals as appropriateIn Derbyshire, referrals to Starting Point will be screened, and if it appears that the criteria for the Disabled Children's Services are met, the referral will be passed to either the North or South Disabled Children's Team, using the Early Help Assessment Process. To meet the criteria a child or young person will have a substantial, enduring and permanent physical, visual, hearing or intellectual impairment or is limited or prevented from undertaking activities appropriate to their daily living. If the criteria for assessment are not met, Starting Point and the Disabled Children's Service a will re-direct referrals as appropriate.
3. Responding to Abuse of Disabled Children
If at any point a practitioner becomes concerned that a disabled child is suffering or likely to suffer Significant Harm, they should consult with their designated lead for child protection and make a referral to Children's Social Care. Concerns should be discussed with a parent prior to making a referral unless it is judged that this action will jeopardise the child's safety. Referrals to Social Care should be made using the same processes as making a referral for any child; see Making a Referral to Social Care Procedure.
In Derby this is via contact with the First Contact Team.
In Derbyshire is via contact with Starting Point.
Where there are concerns that a disabled child is suffering or is likely to suffer Significant Harm, Children's Social Care will convene a Strategy Discussion/Meeting. The Social Worker, their manager, a health professional and a police representative should as a minimum be involved in the strategy discussion. It is also important to include other relevant practitioners involved in the child's care. See Child Protection Section 47 Enquiries Procedure, Strategy Discussions / Meetings.
In addition to considering whether or not the threshold for a Section 47 Enquiry has been met, a strategy discussion must also look at appropriate multi-agency interventions early in the process and seek to minimise risk.
The strategy discussion / meeting should give particular consideration to:
- Ensuring that there is sufficient information about the impact and the context of the specific disability on the child;
- Enabling the child to communicate effectively, sometimes this will require someone who knows the child and their individual style of communication well. They can advise whether the usual method of communication can be used; and
- Whether specialist advice should be sought, who should undertake the investigation, where and how it will take place.
Possible indicators of abuse or significant harm may prove difficult to separate from the effects of a child's impairment; therefore a multi-agency approach involving all practitioners who work with the child is essential and expert advice may be needed.
It is usual for a practitioner from the Disabled Children's Social Work teams to take the lead in any Section 47 Enquiry involving a child already known to them.
Where the concern is about abuse or neglect within the family home, all other children in the household should also be subject to enquiry in the normal way. Sometimes the same Social Worker will undertake the enquiry about all the children though they will need to liaise closely with other practitioners involved with the family. More usually the needs of the family will be better met with a specialist worker and a Reception Team Worker undertaking the enquiry together.
In Derby if it is a disabled child who has allegedly been harmed and where the child is closed or not known to Children and Young People's Services, the Integrated Disabled Children Service will investigate and take to Initial Child Protection Conference. However when the investigations are about a sibling group and there are more non-disabled children in the family, responsibility will be with the Locality Teams. When children are subject to child protection plans, the Locality Teams will only take responsibility if there are more non-disabled children subject to a plan than disabled children.
In relation to safeguarding for disabled children who meet the eligibility criteria for a service from the Derbyshire Disabled Children's Service, management responsibility of the enquiry will lie with the Disabled Children's Service. The Disabled Children's team will undertake all Section 47 enquiries, assessments and legal proceeding in respect of these children. Where a disabled child who meets the criteria is part of a sibling group, the Disabled Children's Team will undertake Single Assessments for all the children. Following this a decision will be taken as to which is the most appropriate team to support the children further. This decision will be made following a discussion between the Service Managers in the Disabled Children's Team and District Team.